Index

AAD. See American Academy of Dermatology (AAD)

ACPM. See American College of Preventive Medicine (ACPM)

Acquired immune deficiency syndrome/ human immunodeficiency virus (AIDS/HIV), 90, 96, 113, 250

See also Infectious agents

ACS. See American Cancer Society (ACS)

Actinic keratoses (AK), 190, 201

Actuarial Research Corporation, 338, 340

ADA. See American Dental Association (ADA)

Africa

Burkitt’s lymphoma in, 250

Age and aging

melanoma incidence/mortality and, 173–174

nonmelanoma skin cancer and, 176

population aged 65 and older, 228–231

preventive services for, U.S. Preventive Services Task Force recommendations, 130

preventive services for, U.S. Preventive Services Task Force recommendations/Medicare coverage comparison, 9, 128–131

skin cancer and, 172, 173

teeth (natural), population 65 and older retaining, 228–231

transplant recipients aged 65 and older, statistics, 258

See also Population

Agency for Health Care Policy and Research (AHCPR), 6, 20, 95, 98, 131, 132, 135.

See also Evidence-Based Practice Centers (EPCs)

AHA. See American Heart Association (AHA)

AIDS/HIV. See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV)

AK. See Actinic keratoses (AK)

Alabama. See University of Alabama

Albuquerque, New Mexico basal cell cancer incidence, 176

Allograft. See Organ transplantation

American Academy of Dermatology (AAD), 38, 210

Melanoma/Skin Cancer Screening Programs, 203

skin cancer screening recommendations, 57

American Cancer Society (ACS), 38, 234

Department of Epidemiology and Surveillance Research, 233



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services Index AAD. See American Academy of Dermatology (AAD) ACPM. See American College of Preventive Medicine (ACPM) Acquired immune deficiency syndrome/ human immunodeficiency virus (AIDS/HIV), 90, 96, 113, 250 See also Infectious agents ACS. See American Cancer Society (ACS) Actinic keratoses (AK), 190, 201 Actuarial Research Corporation, 338, 340 ADA. See American Dental Association (ADA) Africa Burkitt’s lymphoma in, 250 Age and aging melanoma incidence/mortality and, 173–174 nonmelanoma skin cancer and, 176 population aged 65 and older, 228–231 preventive services for, U.S. Preventive Services Task Force recommendations, 130 preventive services for, U.S. Preventive Services Task Force recommendations/Medicare coverage comparison, 9, 128–131 skin cancer and, 172, 173 teeth (natural), population 65 and older retaining, 228–231 transplant recipients aged 65 and older, statistics, 258 See also Population Agency for Health Care Policy and Research (AHCPR), 6, 20, 95, 98, 131, 132, 135. See also Evidence-Based Practice Centers (EPCs) AHA. See American Heart Association (AHA) AIDS/HIV. See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV) AK. See Actinic keratoses (AK) Alabama. See University of Alabama Albuquerque, New Mexico basal cell cancer incidence, 176 Allograft. See Organ transplantation American Academy of Dermatology (AAD), 38, 210 Melanoma/Skin Cancer Screening Programs, 203 skin cancer screening recommendations, 57 American Cancer Society (ACS), 38, 234 Department of Epidemiology and Surveillance Research, 233

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services skin cancer screening recommendations, 58, 178 American College of Physicians Clinical Efficacy Assessment Program, 32 Common Diagnostic Tests: Use and Interpretation, 32 Common Screening Tests, 32 American College of Preventive Medicine (ACPM) skin cancer screening recommendation, 58, 178 American Dental Association (ADA) dental services, medically necessary, statement on, 89 House of Delegates, 89, 223 American Heart Association (AHA), 83–84 Council on Scientific Affairs, 89 dental services, medically necessary, recommendations on, 89–90 American Joint Commission on Cancer Classification, 177 American Society of Transplant Physicians (ASTP). See American Society of Transplantation (AST) American Society of Transplantation (AST) Decade of Transplantation, 123 dental services, medically necessary, statement on, 90 immunosuppressive drugs for transplant patients, statement on, 123 Annals of Internal Medicine, 89 Antibodies immunosuppression therapy for transplant patients, 290 See also Immunosuppressive drugs Antiproliferative agents transplant patients’ use of, 290–291 See also Immunosuppressive drugs AST. See American Society of Transplantation (AST) ASTP. See American Society of Transplantation (AST) Australia Geraldton, Western Australia, skin cancer incidence, 175–176 immunosuppression maintenance trials, 291 Queensland, skin cancer incidence, 173, 175 skin cancer incidence, 60–61, 174, 175–176 skin cancer screening, 3, 52, 60, 189–190, 201, 203, 204–205 skin cancer screening, public information campaigns, 207 Azathioprine, 290–291 AZT. See Zidovudine (AZT) Balanced Budget Act of 1997, 1, 13–14, 15, 18, 65, 66, 67, 118, 127, 222, 329 Balanced Budget Act Refinements of 1999, 2, 100 Basal cell carcinoma. See Nonmelanoma skin cancers (NMSC) Behavioral Risk Factor Surveillance System (BRFSS), 231 Bethesda, Maryland, 235 Bias lead-time bias in skin cancer screening, 53 length bias in skin cancer screening and, 53 Blood poisoning. See Septicemia Blue Cross and Blue Shield Association, 32 Technical Evaluation Center, 21 Bone cell death. See Osteoradionecrosis (ORN) Bone marrow transplantation (BMT), 250, 254 oral complications of, leukemia patients, 252 oral mucositis from, leukemia patients, potentially effective treatments, 257 See also Organ transplantation Breslow measurement technique melanoma and, 177 BRFSS. See Behavioral Risk Factor Surveillance System (BRFSS) British Columbia. See Canada Burden of disease, 25 head/neck cancer, 69–71, 91 heart valve repair/replacement, 83–85, 94 immunosuppressive drugs for transplant patients, drug noncompliance, 124 leukemia, 75–76, 92, 249 lymphoma, 76–77, 93, 250–251 melanoma, 43–44, 173–174 nonmelanoma skin cancers, 44–45, 175–176 skin cancer, 43–45, 173–176

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services transplantation, 80, 93–94, 104–108, 124 See also Diseases and disorders Calcijex®, 296 Calcineurin phosphatase inhibitors transplant patients’ use of, 292–293 See also Immunosuppressive drugs California. See University of California at Los Angeles (UCLA) CAN. See Chronic allograft nephropathy (CAN) Canada British Columbia, basal cell cancer incidence, 175 British Columbia, melanoma incidence, 191 cancer registries, 175 community-based screening programs, 137 immunosuppression maintenance trials, 291 renal transplantation analysis, 110 Toronto, osteoradionecrosis in hospital patients, 245 Canadian Task Force on the Periodic Health Examination (CTFPHE), 31, 33 Canady, Charles, 322 Cancer. See Head and neck cancer; Leukemia; Lymphoma; Melanoma; Nonmelanoma skin cancers (NMSC); Skin cancer; Skin cancer screening; Tumor, node, metastasis (TNM) system Cardiopulmonary resuscitation (CPR), 129, 130 Cardiovascular diseases and disorders. See Endocarditis; Valvular heart disease Carrier Advisory Committees, 21 Case-control studies melanoma mortality, skin self-examination effects on, 206–207 CBO. See Congressional Budget Office (CBO) CDC. See Centers for Disease Control and Prevention (CDC) CE. See Cost-effectiveness (CE) analysis Centers for Disease Control and Prevention (CDC), 90 Chapel Hill, North Carolina. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC) Chemotherapy, 76, 77 dental pretreatment, septicemia reduction role for leukemia/lymphoma patients, 255–256 oral complications of, leukemia/lymphoma patients, 78, 251–252 oral mucositis from, leukemia/lymphoma patients, potentially effective treatments, 257 See also Medical tests and procedures Chicago, Illinois. See University of Chicago Hospitals Chronic allograft nephropathy (CAN), 299, 301 Committee on Medicare Coverage Extensions analytic strategy of, 29–33 criteria and trade-offs, 27–29 dental services, medically necessary, Medicare coverage extension, assessment approach, 66–69 dental services, medically necessary, Medicare coverage extension, conclusions, 5–7, 96–98 dental services, medically necessary, Medicare coverage extension, cost estimates, 6, 85–88 dental services, medically necessary, Medicare coverage extension, findings, 91–95 dental services, medically necessary, research directions, 95–96 evidence/conclusions, linking of, 29, 32–33 health outcomes v. Medicare extension costs, considerations, 29, 35–37 immunosuppressive drugs for transplant patients, assessment approach, 102, 104 immunosuppressive drugs for transplant patients, benefits/harms, findings, 124 immunosuppressive drugs for transplant patients, drug noncompliance, findings, 124 immunosuppressive drugs for transplant patients, Medicare limit elimination, benefits/harms, findings, 125 immunosuppressive drugs for transplant patients, Medicare limit elimination, conclusions, 7–8, 126

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services immunosuppressive drugs for transplant patients, Medicare limit elimination, cost estimates, 8, 118–123 immunosuppressive drugs for transplant patients, Medicare limit elimination, noncompliance effects, findings, 124–125 immunosuppressive drugs for transplant patients, research directions, 125–126 immunosuppressive drugs for transplant patients, treatment effectiveness, findings, 124 intervention definition, 29, 30–31, 67 Medicare coverage extensions, costs estimation, xi, 29, 33–37, 329 methods, 25, 26–37 objectives, 26–29 outcomes definition, 29, 30–31, 67–68 population definition, 29, 30–31, 67 principles for reaching conclusions, 25, 26–29 scientific literature identification/assessment, 29, 31–32 skin cancer screening, Medicare coverage extension, assessment approach, 25, 40–43 skin cancer screening, Medicare coverage extension, assessment criteria, 59–60 skin cancer screening, Medicare coverage extension, conclusions, 3–4, 62 skin cancer screening, Medicare coverage extension, cost estimates, 4, 25, 53–57 skin cancer screening, Medicare coverage extension, findings, 58–61 transplantation, burden of disease, findings, 124 See also Medicare Conclusions and findings dental services, medically necessary, Medicare coverage of, 5–7, 96–98 evidence link with, 27, 29, 32–33 guidelines definition, 33 immunosuppressive drugs for transplant patients, Medicare limit elimination, 7–8, 126 options definition, 33 skin cancer screening, Medicare coverage of, 3–4, 62 standards definition, 33 Congress, xii, 1, 2, 3, 6, 12, 26, 30, 34, 35, 39, 53, 55, 65, 66, 67, 86, 98, 100, 101, 102, 118, 123, 127–128, 130, 131, 132, 134, 135, 139, 310, 314, 320, 321, 322, 329, 349 Medicare creation, xi, 13–17 Medicare decisionmaking role, 8–11, 18–19 See also Legislation; Office of Technology Assessment (OTA); Senate Finance Committee Congressional Budget Office (CBO), 2, 34, 53, 55, 56, 86, 88, 118, 122, 319, 322, 330, 331, 338, 351 See also Congress Connecticut Tumor Registry, 206 See also New Haven, Connecticut Consumer Price Index (CPI), 86, 87, 340 Contractors, private Carrier Advisory Committees, 21 Medicare administrative contractors, decisionmaking role of, 8, 18, 21–22 Peer Review Organizations, 21 Corticosteroids transplant patients’ use of, 292 See also Immunosuppressive drugs Cost-effectiveness (CE) analysis, 29, 34, 36, 37, 129, 131–135, 209–210 Costs. See Health care costs CPI. See Consumer Price Index (CPI) CPR. See Cardiopulmonary resuscitation (CPR) “Crowd out” definition of, 118 CTFPHE. See Canadian Task Force on the Periodic Health Examination (CTFPHE) Cyclosporine A (CyA), 114, 262, 292–293, 301, 312–313 Cytomegalovirus (CMV). See Infectious agents Dade County, Florida skin examinations, survey of physicians, 55 DALYs. See Disability-adjusted life years (DALYs) Databases. See MEDLINE DCP. See Dental care program (DCP) Deaths. See Mortality

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services Decayed, missing and filled tooth surfaces (DMFS), 240. See also Oral health Denmark cancer registries, 175 Dental care program (DCP), 239–240. See also Dental services, medically necessary; Oral health Dental services chemotherapy pretreatment, septicemia reduction role for leukemia/lymphoma patients, 76, 78, 79, 92, 93, 97, 255–256 head/neck cancer patients and osteoradionecrosis, role of hyperbaric oxygen therapy, 75, 90, 244–245 head/neck cancer patients and osteoradionecrosis of jaws, treatment required, 72, 74, 75, 91, 97, 245–246 head/neck cancer patients, preservation influence on osteoradionecrosis incidence in, 241, 243–244, 248 head/neck cancer patients, pretreatment approaches, efficacy of, 239–240 head/neck cancer patients, pretreatment assessment, 237–238 head/neck cancer patients, preventive treatment needs, 238 Medicare current coverage, 5, 63–65, 68, 224–228, 230 oral mucositis from chemotherapy/bone marrow transplantation, potentially effective treatments, 257 See also Dental care program (DCP); Oral health Dental services, medically necessary analytic approach, 86, 96–97, 98, 233 benefits/harms of intervention, 25 burden of illness, 25 Committee on Medicare Coverage Extensions, objectives, 26–27 decision analytic framework for, 232–233 decision framework for, 231–232 definition of, 65–66, 223–224 head/neck cancer patients, benefits/ harms of, 92, 246–247 head/neck cancer patients in radiation, care for, 73 head/neck cancer patients, literature review, observations on, 235 head/neck cancer patients, Medicare coverage extension, 234, 247 head/neck cancer patients, Medicare coverage extension, cost estimates, 340 head/neck cancer patients, Medicare coverage extension, cost estimates, statistics, 341, 343 head/neck cancer patients, Medicare coverage extension, costs, methodology, 340 head/neck cancer patients, Medicare coverage extension, methods, 234–235 head/neck cancer patients, Medicare current coverage, 68, 230 head/neck cancer patients, outcome effects of, 74–75, 92, 246–247 head/neck cancer patients, treatment oral complications, 225, 234 heart repair/replacement patients, 269, 271 heart repair/replacement patients, benefits/harms, committee findings, 95 heart repair/replacement patients, care for, 84–85 heart repair/replacement patients, Medicare coverage extension, cost estimates, 345 heart repair/replacement patients, Medicare coverage extension, cost estimates, statistics, 348 heart repair/replacement patients, Medicare coverage extension, costs, methodology, 347 heart repair/replacement patients, Medicare current coverage, 68, 230 heart repair/replacement patients, outcome effects of, 85, 94–95 heart repair/replacement patients, treatment oral complications, 225 leukemia/lymphoma patients, Medicare coverage extension, cost estimates, 342 leukemia/lymphoma patients, Medicare coverage extension, cost estimates, statistics, 344 leukemia/lymphoma patients, Medicare coverage extension, costs, methodology, 342, 345 leukemia patients, benefits/harms of, committee findings, 92–93 leukemia patients, care for, 78–80, 247, 248–249

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services leukemia patients, Medicare current coverage, 68, 230 leukemia patients, outcome effects of, 79–80, 92 leukemia patients, treatment oral complications, 226 lymphoma patients, benefits/harms of, committee findings, 93 lymphoma patients, care for, 78–79, 247, 250 lymphoma patients, Medicare current coverage, 68, 230 lymphoma patients, outcome effects of, 79–80, 93 lymphoma patients, treatment oral complications, 226 medical conditions considered for, 224, 226 Medicare coverage extension, xi, 4–5, 14, 268 Medicare coverage extension, and access to/use of, 22, 23 Medicare coverage extension, committee assessment approach, 66–69 Medicare coverage extension, committee conclusions, 5–7, 96–98 Medicare coverage extension, committee findings on, 91–95 Medicare coverage extension, cost estimates, 6, 25, 85–88, 336, 338, 340, 342, 345 Medicare coverage extension, cost estimates, statistics, 339, 341, 343, 344, 346, 348 Medicare coverage extension, costs, methodology, 340, 342, 345, 347 Medicare coverage extension, rationales, 22 Medicare coverage extension, research suggestions, 95–96 Medicare current coverage, 5, 63–65, 68, 224–228, 230 overview of, 222–233 statements of others on, 89–91 transplant patients, benefits/harms of, 94, 267 transplant patients, care after, 82, 265–266 transplant patients, care before, 82, 263–264 transplant patients, medically necessary services, 264 transplant patients, Medicare coverage extension, 85–88, 97–98, 257–259, 268 transplant patients, Medicare coverage extension, cost estimates, 85–88, 345 transplant patients, Medicare coverage extension, cost estimates, statistics, 346 transplant patients, Medicare coverage extension, costs, methodology, 345 transplant patients, Medicare current coverage, 68, 230, 266 transplant patients, oral infection and, 65, 78, 79, 80–81, 82, 94, 260–262 transplant patients, outcome effects of, 82–83, 94 transplant patients, review methods, 260 transplant patients, treatment of oral complications, 65, 66, 67, 69, 79, 225 See also Dental care program (DCP); Dental services; Oral health Dentists and dentistry. See Dental care program (DCP); Dental services; Dental services, medically necessary; Oral health Department of Health and Human Services (DHHS), 1, 9, 12, 13–14, 19, 129, 131, 134, 222 “Put Prevention into Practice” initiative, 137 See also Health Care Financing Administration (HCFA) DeWine, Mike, 322 DHHS. See Department of Health and Human Services (DHHS) Diagnosis-related groups (DRGs), 270, 347; see also Medicare Dialysis, 100–101, 104, 110, 124, 126 costs to Medicare of, 116, 119, 121, 122, 296–297 mortality compared to transplant patients, 298 See also Medical tests and procedures Digital rectal examination (DRE), 128 Disability-adjusted life years (DALYs), 36 Diseases and disorders dental services, medically necessary, clinical conditions considered for, 224 See also Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV); Actinic keratoses

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services (AK); Burden of disease; Endocarditis; End-stage renal disease (ESRD); Epidemiology; Head and neck cancer; Infectious agents; Leukemia; Lymphoma; Melanoma; Nonmelanoma skin cancers (NMSC); Osteoradionecrosis (ORN); Septicemia; Skin cancer; Valvular heart disease DMFS. See Decayed, missing and filled tooth surfaces (DMFS) DRE. See Digital rectal examination (DRE) DRGs. See Diagnosis-related groups (DRGs) Drugs See Antibodies; Antiproliferative agents; Calcineurin phosphatase inhibitors; Chemotherapy; Corticosteroids; Immunosuppressive drugs ECRI. See Emergency Care Research Institute (ECRI) Eggers, Paul, 122, 314, 319, 354, 356, 359, 360 Elwood, J.M., 204 Emergency Care Research Institute (ECRI), 21 Endocarditis, 83–85, 89–90, 94, 95, 97 dental-associated, proposed causal model, 84, 85, 95, 269 nonbacterial thrombotic endocarditis (NBTE), 269 See also Diseases and disorders End-stage renal disease (ESRD), 8, 12, 13, 15, 17, 67, 80, 100, 101, 107, 112, 113, 119, 120, 121, 122, 123, 124, 126, 138, 287, 349, 352 dialysis costs for, 297–298 immunosuppressive therapy costs for, 297–298 medical expenditures for, statistics, 122 mortality among dialysis v. transplant patients, 298 therapy costs for, 296–298 transplantation and, Medicare coverage potential modifications, 100–101, 119, 121, 320–324 transplantation and, Medicare current policies’ impact on beneficiaries, 99–101, 102, 103, 111, 121, 122, 315, 317–318, 319, 320 transplantation and, Medicare 1972 policy, 310–311 transplantation and, Medicare 1978 policy, 311–312 transplantation and, Medicare 1984–1986 policy, 312–313 transplantation and, Medicare 1994 policy, 314–315 transplantation costs for, 296–298 See also Diseases and disorders EORTC. See European Organization for Research and Treatment of Cancer (EORTC) EPCs. See Evidence-Based Practice Centers (EPCs) Epidemiology melanoma, 173–175 nonmelanoma skin cancers, 175–176 skin cancer, 173–176 See also Burden of disease; Diseases and disorders Erythropoietin (rHuEPO), 296, 297 ESRD. See End-stage renal disease (ESRD) Ethnicity nonmelanoma skin cancer risk factors, 190 See also Population Europe immunosuppression therapy, 291, 292 skin cancer risk factors, 45 European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30, 246 Evidence-based assessment Medicare coverage and, limits of, 2, 12, 138–139 Medicare decisionmaking and, 20, 132–133, 136 preventive services, Medicare coverage of, overview of, 9–10, 127–131, 136 Evidence-Based Medicine Working Group, 29 Evidence-Based Practice Centers (EPCs), 21, 40, 95 definition/duties of, 20 See also Agency for Health Care Policy and Research (AHCPR) FDA. See Food and Drug Administration (FDA) Federal Register, 20, 131, 331

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services Federation of Special Care Organizations in Dentistry, 338 Finance Committee. See Senate Finance Committee Findings dental services, medically necessary, 91–95 head/neck cancer patients, dental care, benefits/harms, 92 head/neck cancer patients, dental care, burden of disease, 91 head/neck cancer patients, dental care, outcome effects, 91 heart valve repair/replacement patients, dental care, benefits/harms, 95 heart valve repair/replacement patients, dental care, burden of disease, 94 heart valve repair/replacement patients, dental care, outcome effects, 94–95 immunosuppressive drugs for transplant patients, benefits/harms, 124 immunosuppressive drugs for transplant patients, burden from noncompliance, 124 immunosuppressive drugs for transplant patients, Medicare limit elimination, 126 immunosuppressive drugs for transplant patients, Medicare limit elimination benefits/harms, 125 immunosuppressive drugs for transplant patients, Medicare limit elimination noncompliance effects, 124–125 immunosuppressive drugs for transplant patients, treatment effectiveness, 124 leukemia patients, dental care, benefits/harms, 92–93 leukemia patients, dental care, burden of disease, 92 leukemia patients, dental care, outcome effects, 92 lymphoma patients, dental care, benefits/harms, 93 lymphoma patients, dental care, burden of disease, 93 lymphoma patients, dental care, outcome effects, 93 skin cancer screening, Medicare coverage extension, 58–59 transplant patients, dental care, benefits/harms, 94 transplant patients, dental care, burden of disease, 93–94 transplant patients, dental care, outcome effects, 94 transplantation, burden of disease, 124 Florida, 322. See also Dade County, Florida; University of Miami Food and Drug Administration (FDA), 20, 109, 290, 291, 293, 294, 295, 312–313 France skin cancer early detection, benefits, 52 Friends of the NIDCR, 90. See also National Institute of Dental and Craniofacial Research (NIDCR) George Mason University, 117, 125–126 Germany oral cancer patients, dental findings, 238 Graft, medical. See Organ transplantation Great Britain. See United Kingdom Guide to Clinical Preventive Services, Second Edition, 182, 191. See also U.S. Preventive Services Task Force (USPSTF) Hartke, Vance, 311 HBO. See Hyperbaric oxygen (HBO) therapy HCFA. See Health Care Financing Administration (HCFA) Head and neck cancer burden of disease, 69–71, 91, 233–234 dental care for patients, benefits/harms, findings, 92 dental care for patients, findings, 91–92 dental care for patients, literature review, observations on, 235 dental care for patients, Medicare coverage extension, 5, 67, 234, 247 dental care for patients, Medicare coverage extension, conclusions, 97 dental care for patients, Medicare coverage extension, cost estimates, 86, 87, 340 dental care for patients, Medicare coverage extension, cost estimates, statistics, 341, 343 dental care for patients, Medicare coverage extension, costs, methodology, 340 dental care for patients, Medicare coverage extension, methods, 234–235

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services dental care for patients, Medicare current coverage, 68, 230 dental care for radiation therapy patients, 73 dental care for radiation therapy patients, Medicare cost savings, 342, 343 dental disease prevalence in, 73, 88, 91, 92, 238 dental preservation influence on osteoradionecrosis incidence in, 241, 243–244, 248 dental pretreatment approaches, efficacy of, 239–240 dental pretreatment assessment, 237–238 dental preventive treatment needs of, 238 oral complications associated with radiation, 72, 225, 234, 235–237 oral complications associated with radiation, quality of life impact, 246 osteoradionecrosis from postradiation extractions, role of hyperbaric oxygen therapy, 75, 90, 244–245 osteoradionecrosis incidence in, 241, 242 osteoradionecrosis of jaws, treatment required, 73–74, 90, 245–246 outcome, dental care effectiveness for, 74–75, 92 radiation therapy, 71–72, 73 See also Diseases and disorders Health. See Burden of disease; Diseases and disorders; Health care; Health care costs; Health care policy; Health insurance; Health maintenance organizations (HMOs); Health outcomes; Medical tests and procedures; Oral health; Preventive health care Health and Human Services Department. See Department of Health and Human Services (DHHS) Health care access to, Medicare coverage and, 22–24 clinical trial patients, routine care coverage under Medicare, 14 insurance and use of, 23–24 See also Dental services; Dental services, medically necessary; Health care costs; Health care policy; Health insurance; Health outcomes; Medical tests and procedures; Organ transplantation; Oral health; Preventive health care; Surgery Health care costs Committee on Medicare Coverage Extensions, estimation of, 27, 29, 33–37, 329 Committee on Medicare Coverage Extensions, health outcomes v. costs, considerations, 29, 35–37 dental services, medically necessary, Medicare coverage extension, 6, 85–88, 336, 338, 340, 342, 345 dental services, medically necessary, Medicare coverage extension, methodology, 85–88, 340, 342, 345, 347 dental services, medically necessary, Medicare coverage extension, statistics, 85–88, 339, 341, 343, 344, 346, 348 dialysis, costs of, 296–297 end-stage renal disease, expenditures, statistics, 122 end-stage renal disease therapy, costs of, 296–298 head/neck cancer patients, dental care for, Medicare coverage extension, 85–88, 340 head/neck cancer patients, dental care for, Medicare coverage extension, methodology, 85–88, 340 head/neck cancer patients, dental care for, Medicare coverage extension, statistics, 85–88, 341, 343 heart repair/replacement, dental care for, Medicare coverage extension, 85–88, 345 heart repair/replacement, dental care for, Medicare coverage extension, methodology, 85–88, 347 heart repair/replacement, dental care for, Medicare coverage extension, statistics, 85–88, 348 immunosuppressive drugs, cost of, 113, 118–123, 295, 297–298 immunosuppressive drugs, Medicare/alternative funding, expiration of, 113–114 immunosuppressive drugs for transplant patients, Medicare limit elimination, estimates, 8, 118–123, 347, 349–362 immunosuppressive drugs for transplant patients, Medicare limit elimination, methodology, 354, 356, 359–360 immunosuppressive drugs for transplant patients, Medicare limit elimination,

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services statistics, 119, 121, 122–123, 350, 353, 355, 358, 362 insurance and use of health care services, 23–24 leukemia/lymphoma patients, dental care for, Medicare coverage extension, 2 leukemia/lymphoma patients, dental care for, Medicare coverage extension, statistics, 85–88, 344 leukemia/lymphoma patients, dental care for, Medicare coverage extension, methodology, 85–88, 342, 345 Medicare coverage extensions, cost/cost-effectiveness analysis role, 134–136, 139 Medicare coverage extensions, cost estimates, xi, 25, 53–57, 85–88, 118–123, 329–330 Medicare expenditure trends, 17–18 melanoma, screening for, cost-effectiveness studies, results, 207, 208 renal graft loss, Medicare costs of, statistics, 357, 361 skin cancer screening, Medicare coverage extension, 4, 53–57, 330–336, 337 skin cancer screening, Medicare coverage extension, methodology, 53–57, 331, 333, 336 skin cancer screening, Medicare coverage extension, statistics, 53–57, 332, 334, 335, 337 transplantation, costs of, 118–123, 296–298 transplantation, dental care for, Medicare coverage extension, 85–88, 345 transplantation, dental care for, Medicare coverage extension, methodology, 85–88, 345 transplantation, dental care for, Medicare coverage extension, statistics, 346 transplantation, Medicare current policies impact on beneficiaries, 315, 317–318, 319, 320 See also Health care; Health care policy; Health insurance; Oral health; Preventive health care Health Care Financing Administration (HCFA), 5, 6, 17, 34, 35, 63, 67, 73, 75, 82, 88, 97, 98, 118, 131, 132, 134, 135, 314, 356 Carriers Manual, 64, 65 Coverage Issues Manual, 64 Division of Beneficiaries Research, 120, 354, 359 Medicare decisionmaking role of, 8, 10, 11, 18, 19–21, 22 Medicare Provider Analysis and Review (MEDPAR), 270 Office of the Actuary, 55, 120, 330, 333, 338 Technology Advisory Committee, 64 See also Department of Health and Human Services (DHHS); Medicare Coverage Advisory Committee Health care policy congressional decisions for Medicare, 18–19, 127–128, 130, 131, 134, 135, 139 Health Care Financing Administration, decisions for Medicare, 18, 19–21, 131, 132–133, 134, 135 immunosuppressive drugs for transplant patients, Medicare current coverage, 103, 138, 139 Medicare transplantation current policies, impact on beneficiaries, 138, 315, 317–318, 319, 320 Medicare transplantation 1972 policy, 310–311 Medicare transplantation 1978 policy, 311–312 Medicare transplantation 1984–1986 policy, 312–313 Medicare transplantation 1994 policy, 314–315, 317–318 private contractors administering claims for Medicare, 18, 21–22 See also Health care; Health care costs; Health insurance; Oral health; Preventive health care Health Care Policy and Research Agency. See Agency for Health Care Policy and Research (AHCPR) Health insurance health care services use and, 23–24 “Medigap” policy, 17 See also Health care; Health care costs; Medicaid; Medicare Health maintenance organizations (HMOs), 17, 21, 52–53, 137, 138, 319 Health outcomes dental services, medically necessary, committee assessment, 67–68

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services head/neck cancer patients, dental care effects on, 74–75, 92 heart valve repair/replacement, dental care effects on, 84–85, 94–95 leukemia patients, dental care effects on, 79–80, 92 lymphoma patients, dental care effects on, 79–80, 93 Medicare coverage and, 27, 29, 30–31 Medicare coverage and, cost considerations, 35–37 Medicare coverage and health care access/use, impact on, 22–24 Medicare coverage and, limits of, 2, 12, 136–138 melanoma morbidity/mortality, treatment effectiveness, 205–209 nonmelanoma morbidity/mortality, treatment effectiveness, 205 skin cancer morbidity/mortality, early treatment effectiveness for, 205–209, 211 skin cancer morbidity/mortality, screening effects on, 202–203, 210 skin cancer screening and, effectiveness, 60, 179, 180, 181 transplant patients, dental care effects on, 82–83, 94 transplant patients, immunosuppressive drugs for, effectiveness, 124 transplant patients, immunosuppressive drugs for, Medicare coverage effects on, 114–118, 125 Health-related quality of life (HRQL), 246 Heart disease. See Endocarditis; Valvular heart disease Heart valve repair/replacement. See Surgery; Valvular heart disease Herpes simplex virus (HSV). See Infectious agents HIV. See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV) HLA. See Human lymphocyte antigen (HLA) HMOs. See Health maintenance organizations (HMOs) Hodgkin’s disease. See Lymphoma Hospitals and hospitalization heart repair/replacement patients, Medicare discharges, 271 heart repair/replacement patients, Medicare inpatient days, 270, 272 HRQL. See Health-related quality of life (HRQL) Human immunodeficiency virus (HIV). See Acquired immune deficiency syndrome/human immunodeficiency virus (AIDS/HIV) Human lymphocyte antigen (HLA), 289, 299 Hyperbaric oxygen (HBO) therapy, 75, 90, 342 osteoradionecrosis from postradiation extractions in head/neck cancer patients, role of, 244–245 osteoradionecrosis of jaws in head/neck cancer patients, treatment required, 245–246 Immunology transplantation and, overview, 289–290 See also Diseases and disorders; Immunosuppressive drugs Immunosuppression adequate for transplant patients, provision of, 300–301 excessive for transplant patients, avoiding, 302 transplantation and, acute rejection, 106, 107 transplantation and, chronic rejection, 106, 107 transplantation and, need for, 105–106 transplantation and, oral complications, 262 See also Diseases and disorders; Immunology Immunosuppressive drugs Committee on Medicare Coverage Extensions, objectives, 27 costs of, 113 prednisone, 297 transplant patients and, benefits/harms, findings, 124 transplant patients and, costs of, 295, 297–298 transplant patients and, current uses/ future trends, 295–296 transplant patients and, drug compliance/noncompliance, issues, 111–113

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services immunosuppressive drugs for transplant patients, time limit elimination, health outcome effects of, 114, 118, 124 immunosuppressive drugs for transplant patients, time limit elimination, statements on, 123 infrastructure for coverage, 10–11, 131–136 infrastructure for coverage, specific weaknesses, examples, 133–134 leukemia/lymphoma patients, dental care, coverage extension, cost estimates, 342 leukemia/lymphoma patients, dental care, coverage extension, cost estimates, statistics, 344 leukemia/lymphoma patients, dental care, coverage extension, costs, methodology, 342, 345 leukemia patients, dental care current coverage, 68, 230 lymphoma patients, dental care current coverage, 68, 230 Medicare Provider Analysis and Review (MEDPAR), 270 overview of, xi, 1–2, 13–15 Part A, 15–16, 17, 21, 64, 226, 227, 330 Part B, 15, 16, 21, 34–35, 64, 86, 87, 88, 119, 122, 128, 226, 227, 234, 258, 266, 330, 331, 333, 336, 340, 345, 349 Part C, 15 Physician Fee Schedule, 55 preventive services coverage, evidence-based assessment, limits of, 2, 12, 138–139 preventive services coverage, evidence-based assessment role, 9–10, 127–131, 136 preventive services coverage, health outcome limits of, 2, 12, 136–138 preventive services coverage, overview, 8–11 preventive services current coverage and U.S. Preventive Services Task Force recommendations, comparison, 9, 128–131 preventive services current coverage, listing, 128 renal graft loss, cost to, statistics, 357, 361 skin cancer screening, coverage extension, xi, 2–3, 14, 22, 25 skin cancer screening, coverage extension, assessment approach, 40–43 skin cancer screening, coverage extension, assessment criteria, 59–60 skin cancer screening, coverage extension, conclusions, 3–4, 62 skin cancer screening, coverage extension, cost estimates, 4, 53–57, 330–336, 337 skin cancer screening, coverage extension, cost estimates, statistics, 332, 334, 335, 337 skin cancer screening, coverage extension, costs, methodology, 331, 333, 336 skin cancer screening, coverage extension, findings, 58–61 skin cancer screening, coverage extension, overview, 38–40 skin cancer screening, coverage extension, pathway, 49 skin cancer screening, current coverage, 3 technology assessment commitment, decisionmaking role of, 20, 132–133 transplantation, costs, 296–298 transplantation, coverage of, 287 transplantation, current policies’ impact on beneficiaries, 315, 317–318, 319, 320 transplantation, dental care for, coverage extension, 257–259 transplantation, dental care for, coverage extension, cost estimates, 345 transplantation, dental care for, coverage extension, cost estimates, statistics, 346 transplantation, dental care for, coverage extension, costs, methodology, 345 transplantation, dental care for, current coverage, 68, 230 transplantation, dental care for, review methods, 260 transplantation, 1972 policy, 310–311 transplantation, 1978 policy, 311–312 transplantation, 1984–1986 policy, 312–313 transplantation, 1994 policy, 314–315, 318–320 transplantation, potential modifications to program, 320–324

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services See also Committee on Medicare Coverage Extensions; Diagnosis-related groups (DRGs); Health insurance; Medicare Coverage Advisory Committee; Medicare Secondary Payer (MSP) Medicare Coverage Advisory Committee, 20, 131 objectives, 26–27 principles, 27 See also Health Care Financing Administration (HCFA); Medicare Medicare Coverage Extensions Committee. See Committee on Medicare Coverage Extensions Medicare Secondary Payer (MSP), 349, 351. See also Medicare MEDLINE, 182, 234, 247, 260, 270 Melanoma ABCDE checklist for, 47, 49, 176 Breslow measurement technique, 177 burden of disease, 43–44, 173–176 diagnosis, 44, 47–48, 52, 53, 60, 176–177 diagnosis delay, consequences of, retrospective studies, 208–209 epidemiology, 173–176 incidence/mortality, age and, 42, 43–44, 173, 174 malignant lesions found in screening, data on, 200 mortality and stages found in screening v. usual practice, studies results, 207, 208 mortality, skin self-examination effects, case-control study, 206–207 natural history, 176–177 risk factors, 40–41, 43, 44–45, 49–50, 62, 191–192 screening for, cost-effectiveness studies, results, 42, 56, 61, 209–210 screening tests, 48–50, 60, 182, 184–193 staging, 177 treatment, availability of, 45–46 treatment, early, effectiveness of, studies results, 39, 50–51, 60, 62, 205–209, 213 warning symptoms, 38 See also Diseases and disorders; Nonmelanoma skin cancers (NMSC); Skin cancer; Skin cancer screening Methods and methodology analytic strategy, 27, 29–33 cost estimation, 27, 29, 33–37 dental services, medically necessary, analytic approach, 233 dental services, medically necessary, decision analytic framework, 232–233 dental services, medically necessary, decision framework, 231–232 dental services, medically necessary, Medicare coverage extension, assessment approach, 66–69 dental services, medically necessary, Medicare coverage extension for, costs, 340, 342, 345, 347 head/neck cancer patients, dental care for, 234–235 head/neck cancer patients, dental care for, Medicare coverage extension, costs, 340 heart valve repair/replacement patients, dental care for, Medicare coverage extension to, costs, 347 heart valve repair/replacement patients, dental care for, review methods, 270–271 immunosuppressive drugs for transplant patients, Medicare limit elimination, assessment, 102, 104 immunosuppressive drugs for transplant patients, Medicare limit elimination, costs, 354, 356, 359–360 leukemia/lymphoma, dental care for, 247 leukemia/lymphoma, dental care for, Medicare coverage extension to, costs, 342, 345 medical intervention, evidence pyramid for assessing, 28, 29 skin cancer screening, data extraction/synthesis, 182–184 skin cancer screening, literature review, 182 skin cancer screening, Medicare coverage extension, assessment approach, 40–43 skin cancer screening, Medicare coverage extension, costs, 331, 333, 336 transplantation, dental care for, Medicare coverage extension to, costs, 345 transplantation, dental care for, review methods, 260

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services Miami, Florida. See University of Miami Microorganisms. See Infectious agents Minnesota. See Olmstead County, Minnesota; Rochester, Minnesota MMF. See Mycophenolate mofetil (MMF) Models and modeling dental services, medically necessary, 223 dental services, medically necessary, decision model, 231 endocarditis, dental-associated, proposed causal model, 269 immunosuppressive drugs for transplant patients, Medicare coverage extension, estimated costs, 119, 120, 121, 122–123 skin cancer screening, Medicare coverage extension, cost estimates, 55 Mortality dialysis v. renal transplantation, comparison, 298 melanoma, age and, 173–176 melanoma, skin self-examination effects on, case-control study, 206–207 melanoma, stages found in screening v. usual practice, studies, 207, 208 skin cancer, 172 skin cancer early treatment, effectiveness of, 205–209 skin cancer, screening effects on, 39, 41, 42, 52, 53, 58, 59, 60, 204, 205, 212 See also Burden of disease; Population MSP. See Medicare Secondary Payer (MSP) Mucositis. See Oral mucositis Murray, Joseph, 287, 288 Mycophenolate mofetil (MMF), 290–291 National Academy of Sciences (NAS), 1, 13–14, 24, 222. See also Institute of Medicine (IOM) National Alliance for Oral Health, 223 National Cancer Institute (NCI), 43, 44, 46, 90, 173, 233 PDQ information system, 57 skin cancer screening statement, 57–58 See also Surveillance, Epidemiology and End Results (SEER) program National Committee for Quality Assurance (NCQA), 137 National Health and Nutrition Examination Survey (NHANES), 81, 228, 231, 263 National Health Examination Survey, 228 National Health Interview Survey, 230 National Institute of Dental and Craniofacial Research (NIDCR), 95 dental services, medically necessary, statement on, 90–91 Oral Health, Cancer Care and You: Fitting the Pieces Together, 90 See also Friends of the NIDCR; National Institutes of Health (NIH) National Institute of Dental Research, 228 National Institute of Nursing Research, 90 National Institutes of Health (NIH), 6, 11, 98, 132, 133, 301 Consensus Development Conference on Oral Complications of Cancer Therapies: Diagnosis, Prevention, and Treatment, 1989, 90, 235 dental services, medically necessary, statement on, 90 skin cancer screening statements, 57–58 See also National Institute of Dental and Craniofacial Research (NIDCR) National Kidney Foundation (NKF), 117, 125–126 immunosuppressive drugs for transplant patients, statement on, 123 National Medical Expenditure Survey, 1987, 88, 340 National Oral Health Information Clearinghouse, 90 National Organization for Rare Diseases (NORD), 115, 116 National Organ Transplant Act of 1984, 313, 321 National Task Force on Organ Transplantation, 313 NBTE. See Endocarditis NCI. See National Cancer Institute (NCI) NCQA. See National Committee for Quality Assurance (NCQA) Neck cancer. See Head and neck cancer Neoral®, 293, 297 Netherlands skin cancer screening study, 185, 188 New England Journal of Medicine “Clinical Problem Solving,” 29 New Hampshire nonmelanoma skin cancer incidence, 176 New Haven, Connecticut skin examinations, survey of physicians, 55

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services New Mexico. See Albuquerque, New Mexico New Zealand skin cancer trends, 174 NHANES. See National Health and Nutrition Examination Survey (NHANES) NIDCR. See National Institute of Dental and Craniofacial Research (NIDCR) NIH. See National Institutes of Health (NIH) Nixon, Richard M., 311 NKF. See National Kidney Foundation (NKF) NMSC. See Nonmelanoma skin cancers (NMSC) Nonbacterial thrombotic endocarditis (NBTE). See Endocarditis Non-Hodgkin’s lymphoma. See Lymphoma Nonmelanoma skin cancers (NMSC) (basal cell and squamous cell) burden of disease, 44–45, 175–176 diagnosis, 177–178 epidemiology, 175–176 natural history, 177–178 Psorolen plus ultraviolet-A radiation and, 178 risk factors, 190 staging, 177–178 treatment, availability of, 46 treatment, early, effectiveness of, studies results, 205, 213 warning symptoms, 38 See also Diseases and disorders; Melanoma; Skin cancer; Skin cancer screening NORD. See National Organization for Rare Diseases (NORD) North Carolina. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC) OBRA 1986. See Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) OBRA 1987. See Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) Office of Technology Assessment (OTA), 9, 19, 132, 134, 314, 322, 323 immunosuppressive drugs for transplant patients, statement on, 123 Outpatient Immunosuppressive Drugs Under Medicare, 123 See also Congress Ohio, 322 Olmstead County, Minnesota, 84 Omnibus Budget Reconciliation Act of 1986 (OBRA 1986), 313, 321 Omnibus Budget Reconciliation Act of 1987 (OBRA 1987), 314 OPTN. See Organ Procurement and Transplantation Network (OPTN) Oral cavity cancer. See Head and neck cancer Oral health bone marrow transplantation for leukemia patients, complications of, 252 chemotherapy for leukemia/lymphoma patients, complications of, 251–252 endocarditis, dental-associated, proposed causal model, 269 head/neck cancer patients, dental disease prevalence in, 238 head/neck cancer patients, radiation complications, 72, 225, 235–237 head/neck cancer patients, radiation complications, quality-of-life impact, 246 heart valve repair/replacement, related problems, 84, 225 Hodgkin’s disease, considerations in, 251, 252, 253 immunosuppression therapy for transplant patients, complications, 262 infections and organ transplantation, 260–262 lesions and transplantation, 266 leukemia, related problems, 76, 249–250 leukemia treatment, related problems, 78, 225, 250, 251–252 lymphoma, related problems, 77, 251 lymphoma treatment, related problems, 78, 225, 251–252 non-Hodgkin’s lymphoma, considerations in, 254 population age 65 and older retaining natural teeth, 228–231 septicemia sources in leukemia/lymphoma patients, 252–255 transplantation, considerations after, 265–266 transplantation, considerations before, 263–264 transplantation, infections and, 260–262 transplantation, lesions in, 266

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services transplantation, related problems, 80–81, 225, 260–262 See also Decayed, missing and filled tooth surfaces (DMFS); Dental care program (DCP); Dental services; Dental services, medically necessary; Diseases and disorders; Health care; Health care policy; Oral mucositis; Osteoradionecrosis (ORN) Oral mucositis chemotherapy/bone marrow transplantation and, potentially effective treatments for, 257 See also Oral health Oregon health care reform initiative, 139 Oregon Health Sciences University Evidence-Based Practice Center, 40 Organ Procurement and Transplantation Network (OPTN), 313 Organ transplantation acute rejection, 106, 107 age 65 and older, recipients of, statistics, 258 antibodies, immunosuppressive use of, 290 antiproliferative agents, immunosuppressive use of, 290–291 azathioprine, immunosuppressive use of, 290–291 burden of disease, 80, 93–94, 104–108, 124 calcineurin phosphatase inhibitors, immunosuppressive use of, 292, 293 chronic rejection, 106, 107 corticosteroids, immunosuppressive use of, 292 costs of, 296–298 cyclosporine, immunosuppressive use of, 292, 293 dental care and, after surgery, 82, 265–266, 267 dental care and, before surgery, 82, 263–264, 267 dental care and, benefits/harms, 94, 267 dental care and, committee findings, 93–94 dental care and, Medicare coverage extension, 5, 67, 257–259, 268 dental care and, Medicare coverage extension, committee conclusions, 97–98 dental care and, Medicare coverage extension, cost estimates, 85–88, 345 dental care and, Medicare coverage extension, cost estimates, statistics, 346 dental care and, Medicare coverage extension, costs, methodology, 345 dental care and, Medicare current coverage of, 68, 230, 266 dental care and, review methods, 260 dental care considered medically necessary, 264 heart/liver/lung, immunosuppressive drugs for, Medicare coverage extension, costs, 360, 362 immunology and, overview, 289–290 immunosuppression, adequate, provision of, 300–301 immunosuppression, excessive, avoiding, 302 immunosuppression, need for, 105–107 immunosuppression therapy and, oral complications, 262, 267 immunosuppressive drugs currently available, cost of, 294 immunosuppressive drugs for, adequate therapy, barriers to, 111–118 immunosuppressive drugs for, benefits/harms, findings, 124 immunosuppressive drugs for, burden from patient noncompliance, findings, 124 immunosuppressive drugs for, burden of disease, 25 immunosuppressive drugs for, committee assessment approach, 102, 104 immunosuppressive drugs for, compliance/noncompliance, issues, 111–113 immunosuppressive drugs for, costs of, 296–298 immunosuppressive drugs for, current uses/future trends, 294–296 immunosuppressive drugs for, intervention, 25 immunosuppressive drugs for, Medicare/alternative funding, expiration of, 113–114 immunosuppressive drugs for, Medicare coverage benefits/harms, 104, 125 immunosuppressive drugs for, Medicare coverage evolution, 100–102, 103, 287, 310–315

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services immunosuppressive drugs for, Medicare coverage extension, xi, 14 immunosuppressive drugs for, Medicare coverage extension, conclusions, 126 immunosuppressive drugs for, Medicare coverage extension, cost estimates, 25, 118–123, 347, 349–362 immunosuppressive drugs for, Medicare coverage extension, cost estimates, statistics, 350, 353, 355, 358, 362 immunosuppressive drugs for, Medicare coverage extension, costs, methodology, 354, 356, 359–360 immunosuppressive drugs for, Medicare coverage extension, Medicaid cost savings, 351–352 immunosuppressive drugs for, Medicare coverage extension, rationales for, 22, 23 immunosuppressive drugs for, Medicare coverage extension, statements on, 123 immunosuppressive drugs for, Medicare coverage, health outcomes effects of, 114–118, 124 immunosuppressive drugs for, Medicare coverage, noncompliance effects of, 124–125 immunosuppressive drugs for, Medicare current coverage policy, 103 immunosuppressive drugs for, noncompliance of patients, findings, 124, 299, 319, 320, 321, 323 immunosuppressive drugs for, overview, 99–100 immunosuppressive drugs for, pharmacology of, 289–295 immunosuppressive drugs for, research directions, 125–126 immunosuppressive drugs for, treatment benefits/harms, 25, 104, 109–110 immunosuppressive drugs for, treatment effectiveness, findings, 124 Medicare coverage for, introduction, 100–101, 122, 287 Medicare coverage, potential modifications to, 320–324 Medicare current policies’ impact on beneficiaries, 315, 317–318, 319, 320 Medicare 1972 policy for, 310–311 Medicare 1978 policy for, 311–312 Medicare 1984–1986 policy for, 312–313 Medicare 1994 policy for, 314–315, 317–318 mortality compared with dialysis patients, 298 Mycophenolate mofetil (MMF), immunosuppressive use of, 290–291 oral health problems associated with, 80–81, 225 oral infections in, 260–262, 267 oral lesions in, 266 outcomes, dental care effectiveness for, 82–83, 94 outcomes, expected, beyond 3 years, 287–289 protein-based therapy, immunosuppressive use, 290 rejection, late, in nonrenal transplants, causes, 300 rejection, late, in renal transplants, causes, 298–300 renal graft loss, Medicare costs of, statistics, 357, 361 renal, immunosuppressive drugs for, Medicare coverage extension, cost estimates, 352, 353, 354, 355, 356, 358, 359–360 statistics, by organ type, 105, 259 survival, long-term, barriers to, 300 survival, long-term, impacts of, 317–318 survival, long-term, scientific basis, 287–296 survival rates, statistics by organ type, 109 tacrolimus, immunosuppressive use of, 293 treatment, effective, availability, 109–110 waiting list for, statistics by organ type, 108, 259 waiting lists for, 107 See also Bone marrow transplantation (BMT); Medical tests and procedures; Surgery Organ Transplantation National Task Force. See National Task Force on Organ Transplantation Osteoradionecrosis (ORN), 72, 73, 74, 75, 90, 91, 92, 97, 342 head/neck cancer patients and ORN of jaws, treatment required, 245–246

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services head/neck cancer patients and postradiation extractions, role of hyperbaric oxygen therapy, 244–245 head/neck cancer patients, dental preservation impact on incidence of, 241, 243–244, 248 head/neck cancer patients, incidence of, 242 head/neck cancer patients in radiation therapy, complications from, 236–237 head/neck cancer patients in radiation therapy, cost savings from preventive care, statistics, 343 See also Oral health OTA. See Office of Technology Assessment (OTA) Peer Review Organizations (PROs), 21 Pennsylvania. See University of Pennsylvania Hospital Pharmacology immunosuppressants, 289–295 Pharynx cancer. See Head and neck cancer P.L. 92–603. See Social Security Amendments of 1972 P.L. 95–292. See Public Law 95–292 P.L. 98–507. See National Organ Transplant Act of 1984 P.L. 99–509. See Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) P.L. 105–33. See Balanced Budget Act of 1997 P.L. 106–113. See Balanced Budget Act Refinements of 1999 Population definition of, assessment approach, 29, 30–31 dental services, medically necessary, definition of, 67 skin cancer screening, definition of, 41 See also Age and aging; Ethnicity; Mortality Population burden of disease. See Burden of disease Preventive health care Medicare coverage, 8–11, 14 Medicare coverage, health outcome limits of, 2, 12, 136–138 Medicare coverage, evidence-based assessment and, 9–10, 127–131, 136 Medicare coverage, evidence limits for, 2, 12, 138–139 Medicare current coverage, and U.S. Preventive Services Task Force recommendations, comparison, 128–131 Medicare current coverage of, listing, 128 U.S. Preventive Services Task Force recommendations for, listing, 130 See also Health care; Health care policy Preventive Services Task Force. See U.S. Preventive Services Task Force (USPSTF) Princess Margaret Hospital, 245 Private industry. See Contractors, private PROs. See Peer Review Organizations (PROs) Prostate specific antigen (PSA), 128 Proteins. See Antibodies PSA. See Prostate specific antigen (PSA) Public Law 92–603. See Social Security Amendments of 1972 Public Law 95–292, 312 Public Law 98–507. See National Organ Transplant Act of 1984 Public Law 99–509. See Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) Public Law 105–33. See Balanced Budget Act of 1997 Public Law 106–113. See Balanced Budget Act Refinements of 1999 Quality-adjusted life years (QALYs), 36, 110, 125 Quality of life head/neck cancer treatment, oral complications from, impact on, 246 Quality of Life Questionnaire QLQ-C30, 246 Race. See Ethnicity RAD. See Sirolimus Radiation therapy head/neck cancer patients, pretreatment dental approaches, efficacy of, 239–240 head/neck cancer patients, pretreatment dental assessment, 237–238 head/neck cancer treatment, 71–72

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services head/neck cancer treatment, dental care for patients, 73 head/neck cancer treatment, dental care for patients, Medicare cost savings, 342, 343 head/neck cancer treatment, oral complications from, 72, 235–237 head/neck cancer treatment, oral complications from, quality of life impact, 246 lymphoma treatment, 77 lymphoma treatment, oral complications from, 78 See also Medical tests and procedures Rapamycin (RAD). See Sirolimus Recommendations. See Conclusions and findings Relative value unit (RVU), 331 Rennie, D., 286 Research dental services, medically necessary, 95–96 head/neck cancer patients, dental services for, literature review observations, 235 immunosuppressive drugs for transplant patients, 125–126 scientific literature identification/assessment by Committee on Medicare Coverage Extensions, 29, 31–32 skin cancer screening, 60–61, 182 Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC), 95 Evidence-Based Practice Center, 95 rHuEPO. See Erythropoietin (rHuEPO) Risk assessment melanoma risk factors, 190–191 nonmelanoma skin cancer risk factors, 190 skin cancer screening use of, accuracy of, 189, 190–193, 210–211 Rocaltrol®, 296 Rochester, Minnesota basal cell cancer incidence, 176 RTI-UNC. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC) RVU. See Relative Value Unit (RVU) SangCyA®, 298 Scientific literature. See Research Scotland. See United Kingdom SEER program. See Surveillance, Epidemiology and End Results (SEER) program Senate Finance Committee, 314. See also Congress Septicemia oral sources of, leukemia/lymphoma patients, 252–255 prechemotherapy dental treatment, role in reduction of, leukemia/lymphoma patients, 255–256 See also Diseases and disorders; Infectious agents Sharp, Lesley, 317 Sirolimus, 295 Skin cancer Breslow measurement technique, 177 diagnosis of, rates from screening, studies, 194–199, 201 diagnostic procedures, 47–48, 176, 178 diagnostic tests accuracy, 50, 179, 180, 181 disease burden, 25, 43–45, 59, 173–176 early detection through screening, compared to usual care, studies, 203 early detection through screening, evidence of benefits, 51–53, 172, 180, 181 epidemiology, 173–176 natural history, 176–177, 178 prevention, primary, 38, 39 prevention, secondary, 38–39 prevention, tertiary, 39 staging, 176–177, 178 suspicious lesions, rate of detection by screening, studies, 193–199 treatment, early, effectiveness of, results, 205–207, 208–209, 213 treatment, effective, availability of, 45–46 treatment effectiveness, 50–51, 60, 181 See also Diseases and disorders; Melanoma; Nonmelanoma skin cancers (NMSC); Skin cancer screening Skin cancer screening ABCDE checklist for, 47, 49, 177, 189 accuracy of test, 48–50, 60, 172 accuracy of test, analytic framework, 180, 181 accuracy of test, results, 184–185, 188–193, 212–213

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services adverse effects of, results, 203–204, 212 analytic framework, 178–181 benefits/harms, findings, 60 benefits/harms, issues, 25, 50–51 biopsies resulting from screening, statistics, 332 follow-up care/biopsies, rates of referral from screening, studies, 194–199, 201 follow-up referral procedure, effects on yield, studies, 202–203 case-finding programs, 178, 181 Committee on Medicare Coverage Extensions, objectives, 26–27 consequences of, analytic framework, 179, 181 consequences of, results, 193–205, 212 data extraction/synthesis methods, 182–184 diagnosis of, rates from, studies, 194–199, 201 early detection through, compared to usual care, studies, 203 early detection through, evidence of benefits, 51–53, 172, 180, 181 health outcome effects of, 60, 178, 179, 181 lead-time bias, 53 length bias, 53 literature review methods, 182 mass-screening programs, 178 Medicare coverage extension, access to/use of, impact on, 22, 23 Medicare coverage extension, assessment approach, 40–43 Medicare coverage extension, assessment criteria, 59–60 Medicare coverage extension, conclusions, 3–4, 62 Medicare coverage extension, cost estimates, 4, 25, 53–57, 330–336, 337 Medicare coverage extension, cost estimates, model, 55 Medicare coverage extension, cost estimates, statistics, 332, 334, 335, 337 Medicare coverage extension, costs, methodology, 331, 333, 336 Medicare coverage extension, findings, 58–61 Medicare coverage extension, intervention assessment, 25, 40–43 Medicare coverage extension, overview, xi, 2–3, 14, 25 Medicare coverage extension, pathway to, 59 Medicare coverage extension, rationales, 22 Medicare current coverage of, 3 melanoma, cost-effectiveness studies, results, 209–210 melanoma malignant lesions found, data on, 193, 200, 201 melanoma stages/mortality found in, comparison to usual practice, studies, 207–208 methods, 182–184 overview, 38–40, 172–173 patient self-care and skin knowledge, effects on, results, 203 procedures, 46–47 questions, key, 178, 180, 181 recommendations on, 57–58, 178 recruitment strategy, effects on yield, studies, 202 research possibilities, 60–61 risk-assessment tools use for, accuracy, 189–193, 212 sensitivity of, definition, 48–49 skin examination type, effects on yield, studies, 202 specificity of, definition, 48, 49 suspicious lesions, rate of detection in, studies, 193–199, 201 total-body examination accuracy, screening/nonscreening studies results, 184–189, 212 yield of, program characteristics effects on, studies, 201, 202–203 See also Medical tests and procedures; Melanoma; Nonmelanoma skin cancers (NMSC); Skin cancer Social Security disability benefits for end-stage renal disease patients, 321 Social Security Act of 1965 (SSA), 13, 15, 63, 226, 258, 266 Social Security Amendments of 1972, 287, 310–311, 322 Squamous cell carcinoma. See Nonmelanoma skin cancers (NMSC) SSA. See Social Security Act of 1965 (SSA)

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services SSI. See Supplemental Security Income (SSI) Starzl, Thomas E., 286 State Kidney Programs, 319 Supplemental Security Income (SSI) renal transplant patients receiving, 318 Surgery heart repair/replacement, dental care for, 84–85 heart repair/replacement, dental care for, Medicare coverage extension, cost estimates, 345 heart repair/replacement, dental care for, Medicare coverage extension, cost estimates, statistics, 348 heart repair/replacement, dental care for, Medicare coverage extension, costs, methodology, 347 heart repair/replacement, dental clinical/radiographic findings, 273 See also Medical tests and procedures; Organ transplantation Surveillance, Epidemiology and End Results (SEER) program, 44, 45, 52, 88, 173, 203, 210, 233–234, 340. See also National Cancer Institute (NCI) Sweden Karolinska Institute, oral infections in bone marrow transplant patients, 254 melanoma incidence, 201 women, melanoma risk-assessment, 191–192 Tacrolimus, 292–293 Task Force on Preventive Services. See U.S. Preventive Services Task Force (USPSTF) Technology assessment Medicare coverage policy use of, 20, 132–133 Technology Assessment Office. See Office of Technology Assessment (OTA) Teeth. See Decayed, missing and filled tooth surfaces (DMFS); Dental care program (DCP); Dental services; Dental services, medically necessary; Oral health Texas, 240 Thurman, Karen, 322 Thymoglobulin®, 293–295 TNM. See Tumor, node, metastasis (TNM) system Total-body skin examination, 184–189, 212 Transplant Amendments Act of 1990, 321 Transplantation. See Organ transplantation Tumor, node, metastasis (TNM) system melanoma staging, 177, 203 UCLA. See University of California at Los Angeles (UCLA) United Kingdom Cheshire, melanoma risk assessment questionnaire, 192–193 London, renal transplant recipients, dental findings, 267 melanoma seven-point checklist, 176–177 osteoradionecrosis study, 245 Scotland, skin cancer screening, 208 Scotland, West of, skin health promotion campaign, 208 skin cancer screening, public information campaigns, 207, 208 United Network for Organ Sharing (UNOS), 87, 104, 259, 349, 360 Scientific Renal Transplant Registry, 288 United States Renal Data System (USRDS), 296 University of Alabama, 297 University of California at Los Angeles (UCLA), 244, 245 University of Chicago Hospitals, 256 University of Maryland Cancer Center, 256 University of Miami, 244 University of North Carolina. See Research Triangle Institute/University of North Carolina at Chapel Hill (RTI-UNC) University of Pennsylvania Hospital Oncology Unit, 255 UNOS. See United Network for Organ Sharing (UNOS) U.S. Preventive Services Task Force (USPSTF), 9, 10, 25, 31, 33, 40, 135, 172, 190–191 dental services, medically necessary, statement on, 89 preventive services recommended for persons 65 and older, listing, 130 preventive services recommended for persons 65 and older, Medicare coverage comparison, 9, 128–131 skin cancer screening, recommendations, 57, 178

OCR for page 367
Extending Medicare Coverage for Preventive and Other Services See also Guide to Clinical Preventive Services, Second Edition USPSTF. See U.S. Preventive Services Task Force (USPSTF) USRDS. See United States Renal Data System (USRDS) Valvular heart disease burden of disease, 83–84, 94 dental care for patients, 84–85, 268, 269 dental care for patients, benefits/harms, findings, 95 dental care for patients, Medicare coverage extension, conclusions, 97–98 dental care for patients, Medicare coverage extension, cost estimates, 86, 87, 345 dental care for patients, Medicare coverage extension, cost estimates, statistics, 348 dental care for patients, Medicare coverage extension, costs, methodology, 347 dental care for patients, Medicare coverage extension, findings, 94–95 dental care for patients, Medicare coverage extension, overview, 5, 67 dental care for patients, Medicare current coverage, 68, 230 dental care for patients, results, 271 dental care for patients, review methods, 270–271 Medicare diagnosis-related groups associated with, 270 Medicare discharges for, 271 Medicare utilization/reimbursement of, 270, 272 oral health problems associated with, 84, 225, 273 outcomes, dental care effectiveness for, 85, 94–95 See also Diseases and disorders Veterans Administration, 258 Medical Centers, 56 Viruses. See Infectious agents Walter Reed Army Medical Center, 74, 239, 240 West Virginia University, 243 Xerostomia. See Oral health Years of healthy life (YHLs), 36 Zidovudine (AZT), 113